There is a significant difference between ketamine treatment with psychotherapy and ketamine treatment without it. Read below to find out which is a better option for you.
If you are reading this page, you likely have already heard about or even researched the effectiveness of ketamine for depression. There is a lot of basic information easily available online about this drug so we will focus specifically on information about ketamine treatment that is more current and specific to its use in psychotherapy. Hopefully this will help you decide whether ketamine with psychotherapy or ketamine alone is best for you.
There are two distinct responses people have to ketamine, the temporary anti-depressant response and the psychedelic response. The one that has been most well researched is the anti-depressant effect that happens almost immediately following an infusion. The other response that gets much less attention is that ketamine induces a very solid altered state of psychedelic consciousness during administration. This psychedelic effect is dependent on the set and setting to fully emerge. If there is a psychotherapist sitting there with you the entire time and engaging you in therapy, the psychedelic effect will deepen and go in directions it simply will not go if you are mostly alone in a room with a nurse checking vitals every 20 minutes. In contrast, the anti-depressant effect is a purely biochemical temporary response that is not dependent on interacting with anyone.
A little known but remarkable fact is that ketamine is acting upon your opioid receptors to produce its antidepressant effect. It is essentially acting like an opioid to block the pain of depression. This surprising finding comes to us through a recent study from Stanford School of Medicine published in the American Journal of Psychiatry (Williams and Heifets, et al., 2018). In a double blind clinical trial, researchers at Stanford gave participants either an opioid blocker or a placebo before they underwent a standard ketamine infusion treatment. As expected, they found that the group that received ketamine without the opioid blocker experienced a 90% reduction in depressive symptoms for a limited period of time. What was unexpected was that the group that received the opioid blocker before the ketamine treatment had virtually no effect on their depressive symptoms. The opioid blocker blocked the anti-depressant effect of ketamine. This is telling us that a significant portion of the anti-depressant response has to do with ketamine acting the same way opioids do in the brain, by numbing pain.
The evidence was so clear that the opioid blocker was preventing the anti-depressant effect of ketamine that the study was ended early so as not to have a negative impact on study participants suffering from depression. There was no doubt that ketamine acts like an opioid on those receptors. One of the authors of the research, Alan Schatzberg, MD, notes, "Before we did the study, I wasn’t sure that ketamine really worked to treat depression. Now I know the drug works, but it doesn’t work like everyone thought it was working.”
We see a similar powerful anti-depressant response to opioid medications such as morphine and Suboxone (the opioid substitute for patients coming off of heroin addiction). We know that the parts of the brain that feel emotional pain are the same parts that feel physical pain (anterior insula and the anterior cingulate cortex). Even mild physical pain medication such as Tylenol (Acetaminophen) was shown to blunt emotionality by 10% to 20%. The anti-depressant effect of ketamine, a far more powerful dissociative anesthetic agent, is acting like a pain killer in its ability to dull both physical and emotional pain. Ketamine does not resolve depression, it numbs the emotional pain of depression. You are being emotionally anesthetized with ketamine.
This is not a slight against ketamine for depression. It can feel like a life saver for people in deep emotional pain or for whom nothing else has worked. As Dr. Heacock notes in the video below, a maintenance schedule of ketamine is far preferable in terms of side effects compared to the very problematic side effects of many medications for depression. We are simply learning more about how similar ketamine is to opioids in lessening depression by increasing dissociation.